Abstract
ObjectivesTo explore the risk factors for fragility fractures in rheumatoid arthritis (RA) patients using a 3-year longitudinal, observational cohort study.MethodsThis RA registry study included consecutive RA patients in the outpatient clinic of Chang Gung Memorial Hospital since September 1, 2014. The demographics, clinical characteristics, lifestyle, evidence of previous fracture, risk factors according to the Fracture Risk Assessment Tool (FRAX®), and the FRAX score of each participant were recorded. The participants were categorized into the new incident fracture (group A) and no incident fracture (group B) groups based on evidence or absence of new incident fractures and propensity score matching (age and gender, 1:2).ResultsOverall, 477 participants completed the 3-year observation period. After matching, 103 and 206 participants were allocated to groups A and B, respectively. The non-adjusted model revealed, presented as hazard ratio (HR) (95% confidence interval [CI]), that the presence of co-morbidity (1.80 [1.17–2.78], p = 0.008), Health Assessment Questionnaire Disability Index (1.35 [1.07–1.69], p = 0.010), lower baseline hip bone mineral density (0.11 [0.02–0.48], p = 0.004), longer disease duration (1.02 [1.00–1.04], p = 0.026), higher FRAX score of major fracture (1.03 [1.02–1.04], p<0.001) or hip fracture (1.03 [1.02–1.04], p<0.001), and previous fracture history (2.65 [1.79–3.94], p<0.001) were associated with new incident fracture. After adjustment, it was disclosed that a previous fracture is an independent risk factor for fragility fractures in RA patients (2.17 [1.20–3.90], p = 0.010).ConclusionsIn addition to aging and disease-related factors, previous fracture history is the most important risk factor for fragility fractures in RA patients.
Highlights
Rheumatoid arthritis (RA) is a chronic, autoimmune, and systemic inflammatory disease characterized by inflammation of the peripheral joints and both local and systemic bone loss
The non-adjusted model revealed, presented as hazard ratio (HR) (95% confidence interval [confidence intervals (CIs)]), that the presence of co-morbidity (1.80 [1.17–2.78], p = 0.008), Health Assessment Questionnaire Disability Index (1.35 [1.07–1.69], p = 0.010), lower baseline hip bone mineral density (0.11 [0.02– 0.48], p = 0.004), longer disease duration (1.02 [1.00–1.04], p = 0.026), higher FRAX score of major fracture (1.03 [1.02–1.04], p
After propensity score matching (PSM) for age and gender (1:2), 103 and 206 participants were allocated to the new incident fracture group and no incident fracture group, respectively (Table 3) [17]
Summary
Rheumatoid arthritis (RA) is a chronic, autoimmune, and systemic inflammatory disease characterized by inflammation of the peripheral joints and both local and systemic bone loss. Several medications, including conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological disease-modifying antirheumatic drugs (bDMARDs), and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), are available. These regimens demonstrated obvious effects on the control of disease activity and improvement of functional disability, and revealed the efficacy of bone loss protection [4]. The incidence of non-vertebral fracture did not change in Japanese patients with RA [5] in the era of biologic application This suggests that anti-osteoporosis medications (AOM) and fragility fracture prevention should be addressed regardless of disease control in patients with RA
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